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Treating Insomnia Key to Managing Anxiety, Depression

September 20, 2017 Articles,Mental Health
guy sitting on bed with head in her hands looking unhappy

Researchers may finally have an answer to what’s been a never-ending chicken-and-egg debate: Are you suffering from insomnia because you’re depressed, or are you depressed because you’re suffering from insomnia?

In what is thought to be the first study large enough to determine the effects of treating insomnia on mental disorders like depression and anxiety, researchers say sleep issues might actually be the reason some people develop such problems in the first place.

“The dominant view is that sleep problems are either a symptom of several mental health problems or a secondary consequence,” said professor Daniel Freeman of the University of Oxford and co-author of the research, in a news release. “What is evident is that the current view of sleep problems needs radical revision. Insomnia isn’t the sole cause of complex psychological problems. But the idea that insomnia is merely a product of these other difficulties doesn’t stack up.”

The Oxford study included more than 3,700 insomnia patients in the United Kingdom. About half received cognitive behavioral therapy (CBT) via an online program called Sleepio. The others acted as a control group and received no treatment. Over the course of the trial, those who received CBT not only slept better, but were also less likely to experience a depressive episode or anxiety, paranoia or hallucinations.

If Sleep Isn’t Happening, Seek Help

On an individual level, the research is a reminder of how vital restful sleep is for our mental health. Skimping on sleep is a mistake, particularly during stressful times, Freeman says. “If sleep isn’t happening for us for a prolonged period, it’s sensible to seek help. Not only will we sleep better, we could be saving ourselves a great deal of distress further down the line.”

It’s believed that people who don’t sleep enough also damage their mental health by denying the brain “housekeeping” time to prune connections and consolidate memories. Giulio Tononi, a renowned sleep researcher at the University of Wisconsin, Madison, published a study that showed that the brain weeds out redundant or unnecessary connections during sleep. This process helps us remember what’s important by letting us clear away what isn’t. And while not a medical researcher, Spanish Nobel Prize in Literature winner Juan Ramón Jiménez called forgetting a virtue, necessary for detachment from the shadows of the past and the anxieties of the future. Insomniacs are afforded no such relief.

When it comes to treating addiction, the Oxford research tells us that drug abuse may actually be prevented with early, robust treatment for serious sleeping issues. How so? Because addiction doesn’t exist in a vacuum. “There’s no such thing as just addiction,” says Christopher La Riche, MD, of Elements Behavioral Health. “It’s always addiction and something else.” So if the insomnia is treated, depression may be prevented, and if depression is prevented, there’s no need for self-medication with alcohol or other drugs.

Treatment Options for People With Sleep Disturbances

The National Sleep Foundation defines insomnia as difficulty falling asleep or staying asleep “at least three nights per week for three months or longer.” People who drink heavily or abuse other substances like cocaine, meth or Ecstasy (MDMA) are among those at the highest risk for insomnia. In fact, according to a study by the National Institutes of Health, some 75% of recovering alcoholics report sleep issues immediately after detox.

So clearly, treating insomnia in rehab and recovery is important. (One of the top concerns people have when they enter drug rehab is how their sleep problems will be addressed.) There are over-the-counter and prescription sleep aids available, but the latter can be risky for individuals in recovery as they too may present an addiction risk. Here are some medications doctors often prescribe for insomnia that have a low risk for addiction:

A non-drug way to treat insomnia, cognitive behavioral therapy is effective whether accessed online or face-to-face with a therapist. Called cognitive behavioral therapy for insomnia (CBT-I), it is considered a first-line treatment (as opposed to medication) by the American College of Physicians and the American Academy of Sleep Medicine. CBT-I includes talk therapy to help combat the racing mind as well as stimulus control, such as avoiding naps and using the bedroom only for sleep. Changing lifestyle habits that affect sleep, like consuming caffeine in the evenings, drinking too much alcohol or not getting daily exercise, are also part of the program. In addition, CBT-I introduces relaxation tips that help participants wind down before bedtime. Think meditation, controlled breathing and guided imagery.

With sleep increasingly being recognized as vital to health — a shortage of shut-eye is blamed not only for mental disorders, but also for physical problems like diabetes, motor vehicle crashes and occupational errors — seek help if you’re having problems falling asleep or staying asleep. According to the Centers for Disease Control and Prevention, one-third of Americans get less than the recommended amount of sleep. Your family doctor or mental health care practitioner can help. Don’t put it off. Your well-being depends on it.

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